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Paper short abstract

This paper focuses on how anthropological and psychiatric modes of knowing attend to people who do not ordinarily express themselves through intentional speech-acts that exteriorize an internal core or inner self, in terms of temporally coherent narrativization.

Paper long abstract

This paper asks: how might anthropological and psychiatric modes of knowing attend to people who do not ordinarily express themselves through intentional speech-acts that exteriorize an internal core or inner self, in terms of temporally coherent narrativization? In psychiatric terms, these are people whose ‘baseline’ communicative styles themselves have been assessed and classified as ‘poverty of speech’, ‘alogia’, ‘mutism’ and so on. These may alternatively be described as non-standardised, atypical or unconventional modes of expression and communication (Marlovitz and Wolf-Meyer 2021; McKearney 2021). Here, the objective for therapy cannot be an ahistorical, noncontextually defined ‘restoration’ of abilities and capacities to communicate in standardised, conventional and typical ways. At the same time, accessing and assessing the person’s mental state through the form and content of their speech – considered by psychiatrists to be the carrier of the form and content of people’s thoughts – itself becomes difficult or even impossible. Through an ethnography of medical student classrooms, an inpatient mental health ward, a community mental health clinic for people with intellectual disabilities in Central London, I focus on psychiatric diagnosis and treatment at the limit of words. The paper thus foregrounds the challenges, frustrations and discomforts amongst psychiatrists when they contend with the opacity or absence of speech that is considered to be the exteriorised carrier of people’s inner life. Patients’ and caregivers' voices are embedded in other forms of embodiment, which psychiatrists must discern through relying less on material markers of 'disordered' speech and thought.